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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
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Summary

Surgical removal of a colorectal tumor is the basic therapy for treating most types of rectal cancer. This colorectal surgery is known as a colectomy. 

There are basically two types of colectomy used with respect to rectal cancer: Low Anterior Resection (LAR) and Abdominoperineal Resection (APR). Each of the different procedures removes the cancer from the colon and from nearby organs if the cancer has spread. One spares the sphincter and one doesn't. 

The key is to understand what will be removed, why it will be removed, and what to expect. For a list of questions to ask, click here.

The other sections of this document provide information starting with preparation for surgery and continuing through recovery. One section compares Open Surgery to Laparoscopic Surgery . 

To find a colorectal surgical specialist in your area, visit the American Society of Colon and Rectal Surgeon’s web site  offsite linkor call in Illinois: 847.290.9184.

NOTE:

  • Radiation treatment is sometimes prescribed for a period of time before surgery to reduce tumor size.
  • For information about hospitals, including how to choose, what to take with you, how to maximize your stay, how to avoid infection, and what to do before discharge, click here.
  • If you are treated in a hospital other than your local hospital,  get a copy of your medical records for the local hospital where you will do the follow up. You are legally entitled to a copy. There may be a charge. For additional information, click here.

Resection: After You Leave The Hospital

After you leave the hospital:

  • Follow up visits:
    • Follow up visits will be scheduled for removal of the staples and to check incision for healing, to discuss results and next steps.
    • There will be another visit 4 – 6 weeks later.
    • After that, there will be quarterly follow-up visits with your surgeon. 
  • Follow the doctor’s orders regarding breathing exercise, food and liquid intake, bathing, exercise and returning to work. The norm for a return to work after major surgery is 3 – 6 weeks. It may be longer if your work involves heavy lifting or other strenuous activity.
  • Start a walking program as soon as you can and to the extent that you are able to. 
    • Walking is good for your bowel function and your lungs. It also helps keep blood clots from forming.
    • Avoid more active movements until your doctor permits.
  • Expect a change in your bowel habits that will get better over time. If the changes are uncomfortable or if they don’t get better, speak with your doctor. There are drugs and bulking agents to consider.
  • The incision:
    • If you feel more than discomfort in or near your incision, let your doctor know. There may be an infection or you may not be receiving enough pain medication.
    • Wear soft, loose clothing over the incision.
    • Do not apply anything on the incision until after the staples are removed and the incision is completely healed unless approved by your doctor.
  • Contact your doctor or other health care professional immediately if:
    • You experience any warmth, see any redness, or drainage that changes color.
    • Something unexpected occurs 
    • If symptoms become intolerable.
  • Ask friends and family to take care of the chores you cannot do. Perhaps a family member can coordinate volunteers. 
    • Free online tools are available to help coordinate care schedules. For example, see the following:
    • Friends can organize meals through such websites as MealTrain offsite link where you can also list foods you do and do not like.
    • As noted above, it is preferable to use a fictitious name so your information does not become public.
  • if you need home care after you leave the hospital, it is available. 
    • The discharge planner in the hospital will help to arrange care.
    • You can either hire an agency, or hire helpers on your own. There are pros and cons to each method which are discussed in the document in "To Learn More."
    • Home care may be covered by your health insurance.

Follow Up:

  • Follow up visits will be scheduled for removal of the staples  or stiches, to check the incision for healing, and to discuss results and next steps.
  • There will be another visit 4 – 6 weeks later.
  • After that, your doctor will let you know how often he or she wants you to follow up. 

 

 

NOTE: 

  • If you haven't already, review the hospital bill. According to a variety of studies, the percentage of hospital bills that are wrong is quite high.It is worth your while to take the time to review the bill – even if it is being paid for entirely by insurance. Survivorship A to Z shows you how, as well as to how to negotiate a hospital bill, in the document in “To Learn More.”  
  • If there are health problems after you get homethe best way to ensure that you are covered by insurance is to return to the same hospital.  For example, postoperative care is part of surgery and follow-up will likely be part of it.  Surgery may begin when you enter the operating room but it does not end when you leave .

For information about life during the recovery period after treatment ends, see: Colorectal Cancer: Post Treatment 0 – 6 Months

A Transanal Resection (also known as "Colectomy" or "Partial Colectomy")

A transanal resection is the removal of small tumors in the lower rectum near the anal opening which have not invaded the layers of the colon and which can be removed with a safety margin of healthy tissue around the tumors.

  • When performed without a scope, the procedure is known as transanal excision (TAE). 
  • When performed with a scope, the procedure is known as transanal endoscopic microsurgery (TAEM). 
  • Both procedures leave the anus and sphincter intact. This allows patients to keep bowel function and eliminates the need for a permanent colostomy.
  • A transanal resection is performed by a colorectal surgeon.  

Types of Colectomies: 

Low anterior resection: This approach is used for cancers near the upper part of the rectum, close to where it connects with the colon. The surgeon makes the cut in the belly. Then he or she removes the cancer and a small amount of normal tissue on either side of the cancer, along with nearby lymph nodes and a large amount of fatty and fibrous tissue around the rectum. The anus is not affected. After the surgery, the colon is reattached to the anus and waste leaves the body in the usual way. 

Proctectomy with colo-anal anastomosis: For some stage I and most stage II and III rectal cancers in the middle and lower third of the rectum, the entire rectum and the colon attached to the anus will need to be removed. This is called a colo-anal anastomosis (anastomosis means "connection"). This is a harder operation to do. For a short time, an ostomy (an opening on the belly for getting rid of body wastes) is needed to allow healing after surgery. A second operation is done later to close the ostomy opening.     

Abdominoperineal (AP) resection: For cancers in the lower part of the rectum, close to its outer connection to the anus, an abdominoperineal (AP) resection is done. For this procedure, the surgeon makes a cut in the belly (abdomen), and another in the area around the anus. Because the anus is removed, a colostomy is needed. A colostomy is an opening of the colon in the front of the abdomen. It is used as a way for the body to get rid of solid body waste (feces or stool). The usual hospital stay for an AP resection is 4 to 7 days, depending on your overall health. 

Pelvic exenteration: If the rectal cancer is growing into nearby organs, more extensive surgery is needed. In a pelvic exenteration the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (an opening to collect urine) is also needed.

Resection: Preparation For A Colectomy

To prepare for a resection:

  • You will be asked to stop:
    • Taking blood thinning drugs for at least a week prior to the procedure. If you are using blood thinning drugs, speak with the prescribing doctor before stopping.
    • Smoking. (For information about how to stop smoking, click here.)
    • Using recreational drugs.
  • You may also be asked to stop taking other medications which your doctor will discuss with you. Speak with the prescribing doctor before stopping.
  • Other preparation procedures vary from doctor to doctor.  As a general matter, in order that your colon be as clean as possible:
    • Enemas and laxatives, accompanied by a lot of fluids, may be given to remove fecal material – just as they were before a colonoscopy or sigmoidoscopy.
    • The day before surgery you will be asked to eat no solid foods and only drink clear liquids. (For information about what is and is not part of a clear liquid diet, click here. While the document refers to a diet before a colonoscopy, it also applies before surgery).
    • While you may want to minimize the prep, keep in mind that if your colon is not clean, the surgery may be postponed.
  • Antibiotics may be prescribed to remove bacteria from the colon. They will likely be continued as a prophylactic against infection.
  • As part of the procedure, you will be asked to sign a form known as “Informed Consent”. 
    • Generally patients first see the form right before surgery begins so there is no time to review it, much less time to make changes. 
    • To assure that you have the time to read and understand everything in the form, ask to see the consent form ahead of time. Don't be surprised if the doctor's staff tells you that the request is unusual. If you do not get to see the form ahead of time, take whatever time you need to understand ieverything in it when you do get the form.
    • If there are words or concepts you do not understand, ask to have them explained to you by your doctor or a qualified member of his or her staff.
    • Make whatever changes you believe are necessary. For example, you may not want to authorize an associate of the doctor's to perform the operation instead of the doctor you met and vetted. For more information, click here.
  • If you have ever had a blood clot in the past, make sure your surgeon knows.  A blood clot can be a dangerous complication of a surgery. If the doctor knows ahead of time, he or she can take steps to lessen the risk.
  • Talk with your surgeon about whether there will be blood loss during the operation and whether you may need a blood transfusion. If you may, consider reducing the already low risk involved in using some one else’s blood.  Alternatives include:
    • Banking your own blood before the operation. Banking your own blood can be expensive. If it is not used, it is thrown out.
    • Use of a machine during an operation that takes your blood, washes it, and returns it to your body.
  • In addition:
    • Check your health and disability insurance policies to find out:
      • What you have to do ahead of time, if anything
      • To learn about how much your share of the costs will be.
    • Think about how you will pay for your share of the medical expenses. (If money is tight, see the documents in "To Learn More.")
    • Make necessary arrangements at work and at home.
    • Sign or revisit your advance healthcare directives which allow you to stay in control of your medical care if you become unable to communicate. An advance directive known as a Health Care Power of Attorney is recommended for everyone. A Health Care Proxy is a person who can make medical decisoins that may need to made if you become unable to communicate. For information about Advance Directives, click here. For infomation about a Health Care Power of Attorney, click here
    • Make sure you have a valid, enforceable Will.
    • For additional steps to take before any surgery, click here. 

Resection: Just Before The Surgery

Just before a resection:

  • A doctor known as an anesthesiologist will administer the anesthesia during the surgery. He or she will meet you with you prior to the procedure to ask questions about your health to determine which anesthesia is best suited for you. Expect questions such as:
    • Current problems such as with your heart or lungs.
    • Allergies including allergies to medicines and food.
    • Whether you smoke and/or drink alcohol. If so, to what degree in general, and what you did or did not do during the past seven days.
    • The list of medications you are taking.
  • You will likely be taken to a staging area close to the operating room where the anesthesiologist will insert an i.v. into your arm.
  • You may be given a drug to help you relax until the surgery starts.

To Learn More

Resection: The Procedure In The Operating Room

In the operating room during a resection:

  • You will be hooked up to several monitoring devices such as a heart monitor and a blood oxygen monitor. 
  • You will fall asleep immediately when the anesthesiologist starts injecting the anesthesia drug. 
  • Once asleep, a tube will be placed in your throat to keep it open during the surgery.
  • The surgery is usually performed by a colorectal or general surgeon and a surgical team including  a scrub nurse to help with the equipment and the anesthesiologist who will monitor your vital signs.
  • The operation involves general anesthesia so there is no pain during the procedure. 
  • What happens during the operation depends on whether the tumor is in the rectum or colon, its size, and whether it has spread.
    • The operation will remove a segment of the rectum which has the cancer as well as a small length of healthy bowel around it. 
    • The two parts of the intestine are reconnected to each other (the procedure is known as an anastomosis). If the two ends of the rectum cannot be sewn together, an opening (a stoma) is made which connects the bowel to the outside of the body so that waste can pass out of the body and into a bag. This is known as a colostomy. If a colostomy is required, it is not likely to be permanent.  (To learn about ostomies, click here.)
    • During the surgery:
      • Biopsies are generally done  to confirm the staging and to determine whether the cancer has spread, including a lymph node dissection to determine if the cancer has spread to the lymph nodes.
      • If the cancer has spread to other organs (metastasized): if only a small number of metastases are present in an organ such as the liver, lungs or ovaries, they may be removed during the surgery.

Resection: Recovery From A Colectomy

Recovery from a resection involves the following:

  • Soon after the operation, you will be taken to the recovery room.  
    • You may be sleepy and not able to stay awake.
    • Your throat may be sore from the breathing tube used during the operation. 
    • You may feel cold. 
    • Don’t be surprised if there are several tubes attached to your body. For instance:
      • A drain in your abdomen to remove excess fluid.
      • An intraveneous line in your arm which is attached to a bag of fluids hanging next to your bed.
      • A Foley catheter in your urethra to help you urinate after surgery. The catheter is usually removed a few days after surgery.
  • When your vital signs are stabilized, you will be moved to a regular hospital room.
    • With a rectal resection, urinary function may change because the nerves may be bruised or injured during the surgery. 
    • Some patients will need a urinary catheter for longer than usual, medication, or both. The loss of urinary control is generally not permanent.
  • Surgery sometimes causes constipation or diarrhea. To avoid constipation your doctor may prescribe a stool softener or laxative for several days after the operation. For tips about dealing with constipation, click here. For tips about dealing with diarrhea, click here.
  • Your health care team will monitor you for signs of bleeding, infection, or other problems requiring immediate treatment.
  • Intake of food and liquid will be restricted for a day or two to give your bowels a chance to recover.
  • With a rectal resection, urinary function may change because the nerves may be bruised or injured during the surgery. Some patients will need a urinary catheter for longer than usual, medication, or both, on a temporary basis.The loss of urinary control is generally not permanent.
  • The day of the surgery or the very next day, you will be asked to walk and move around.  This allows you to expand your lungs which helps prevent pneumona and blood clots. You will also be given breathing exercises to clear your lungs.
  • You may be uncomfortable for the first few days. 
    • You will likely be given narcotic medications for at least 36 hours after surgery to control pain. After that you will be given a decreased amount of pain medications orally.  
    • Do not hesitate to ask for pain medication. Studies show that people who take pain medications after an operation do not become addicted.  
    • Patient activists suggest that you take maximum pain relief at least initially to stay ahead of the pain. (To learn more about pain and dealing with it, see Pain 101)  
  • Fatigue is normal after surgery.
  • Coughing:  If you have an incision in your upper body, you may feel that your incision is going to break apart when you cough – especially if you have open surgery with a large incision. A time tested tip to ease the pain is to use a pillow for support when you cough. Where to hold the pillow depends on where the incision is.
    • If your incision is in the front, hold the pillow against your chest or abdomen. Fold your arms across the pillow. Then cough.
    • If your incision is on your back, lean against the pillow. Then cough.
  • The tube which drains the abdomen will remain in place until nothing flows through it. This usually takes a day or two. 
    • If the urinary (Foley) catheter is removed too soon after surgery it may lead to permanent incontinence. 
    • On the day the catheter comes out, it is advisable to drink extra fluids because your doctor will want to make sure there is no urinary obstruction. (It may still take time to regain your urinary control).    
    • NOTE:  Examine the catheter often to be sure it is secure. If it isn't, contact your medical care provider immediately.     
  • If you have an ostomy:
    • Keep in mind that for most people, an ostomy is temporary. It is needed only until the rectum heals from surgery. After healing takes place, the surgeon reconnects the intestines and closes the stoma. Some people, especially people with a tumor in the lower rectum, need a permanent ostomy.
    • Expect the stoma to be bright red and a bit swollen at first. As time goes on, it will shrink a bit to about a quarter or a half-inch beyond the skin of the abdomen but the distinct red coloration will  remain. There will also be a continual production of cleansing mucus.
    • Your doctor, your nurse, or an enterostomal therapist (a professional trained in ostomies) will teach you how to clean the area and prevent irritation and infection. Experience indicates there are both good and bad experiences with training from nurses who are not specialists in dealing with stomas. You can contact an enterostomal therapist who will talk you through the process even while in the hospital by calling the United Ostomy Association, Tel.: 800.826.0826. 
    • For additional information about ostomies, click here.
  • You will be given antibiotics to prevent infection.
  • Don't be surprised if all kinds of emotions show up - particularly anxiety or depression. 
    • Don’t let your feelings interfere with getting medical care. 
    • Prolonged worry and angst may have an ill effect on your ability to heal physically. There are steps to take to help, including medications and speaking with someone in a similar situlation, or who has been in a similar situation. 
    • If the emotions become burdensome, seek professional counseling.  (For information about dealing with emotions, see the documents in "To Learn More.") 
  • To keep family and friends posted about how you are doing, ask a family member or friend to either create a phone tree on which people keep each other posted easily or a posting on the internet. There are sites specifically for this purpose. For more information, click here. (NOTE: If you will be changing jobs or seeking employment in the foreseeable future, it is preferable to use a phone tree or similar idea to keep people posted. Prospective employers generally search the internet before agreeing to even meet a prospective employee). 

NOTE: Do not be surprised if you do not remember what happens in the recovery room. Your ability to hear and remember information may be impaired until all of the anesthesia is out of your system.

Resection: The Hospital Stay

  • As a general matter, the length of your stay in the hospital depends on whether the surgery was through a traditional larger entry or a small laproscopic incision. As a general matter, with laparascopic surgery, the hospital stay is 3 - 5 days. With open surgery, 5 - 7 days. The ultimate decision about how long you stay in the hospital is your doctor's. The ultimate decision is your doctor's. 
    • The doctor determines when your condition is medically stable so that you can be discharged. 
    • If your insurance company pressures you to leave earlier than the doctor and you think is reasonable, you don't have to go quietly. Appeal. 
    • On the other hand, press firmly if you want to leave earlier than your doctor thinks advisable. 
    • Do not leave a hospital AMA (against medical advice). If you do, you may be stuck with the bill for your entire stay as if you do not have any insurance.
  • Do not hesitate to ask for pain medications. 
    • Studies show that people who take pain medications after an operation do not become addicted. 
    • The vast majority of patients get good pain control with narcotics delivered intravenously (through an i.v.) for up to 36 hours after the operation, and pain pills by mouth thereafter.  
    • Patient advocates suggest that you take maximum pain relief as prescribed rather than waiting to feel the pain at least initially to stay ahead of the pain. To learn more about pain and dealing with it, see Pain 101.
    • Also consider medications or stool softeners to counteract the constricting side effect of pain medications.
    • There is no reason to be in pain in the hospital or after you get home. 
  • Before you leave the hospital, discuss your pain management plan with your doctor. Take prescriptions as offered and have them filled either before you leave the hospital, or as soon as you leave, so you have them when needed. 
  • Fatigue is normal. 
  • Coughing: If you have an incision in your upper body, you may feel that your incision is going to break apart when you cough – especially if you had open surgery with a large incision. Using a pillow and holding it against your incision area when you cough can help decrease the pain and feelings of discomfort. Where to hold the pillow depends on where the incision is. 
    • If your incision is in the front, hold the pillow against your chest or stomach. Fold your arms across the pillow. Then cough. 
    • If your incision is on your back, lean against the pillow. Then cough. 
  • You will be allowed to have visitors on a limited basis - usually limited by hospital policy as to what visitors and how long they can stay with you. If you want a person to visit who is not a blood relative or a legal spouse, consider executing an advance directive known as a Health Care Power of Attorney appointing that person your Health Care Proxy – the person to make medical decisions that may need to be made if you become unable to communicate. (A Health Care Proxy is recommended for everyone to have. For more information, click here).
  • While hospitals are places of healing, mistakes happen and people can pick up infections. For tips about preparing for a stay in hospital, as well as staying safe and maximizing time in a hospital, see the documents in "To Learn More."

The following are myths:

  • You are at the mercy of a hospital bureaucracy to provide what you need when you need it.
  • The patient doesn't have any part to play in taking precautions to avoid medical error and infection. 
  • There is no need to keep track of the services provided in a hospital  because they are included in the basic charge or they will be billed correctly by a computer. 
  • The bill is irrelevant because you are insured.

In fact:

  • In addition to the hospital staff, it is up to you to do what you can to avoid medical error and to avoid getting unnecessary infections which can be potentially deadly. For information about how to avoid medical error and getting an infection in the hospital, click here. 
  • It is up to you to be sure you get what you need in a hospital.  
  • It is also important to keep track of services provided because a large number of hospital bills are wrong. Even if you are insured, you pay a large share of the bill either through co-insurance and/or through an increase in future premiums.

Until you are feeling up to taking care of these tasks by yourself, it is advisable to have a family member or friend with you to act as your advocate as much of the time as possible. The person is known in hospital speak as a Patient Advocate. You or your advocate must make your needs known and see that they are met. (NOTE: If you do not have someone to act as your Patient Advocate, professional patient advocates are available. See "To Learn More.")

The steps you and/or your patient advocate should take are described in the documents in "To Learn More." In general, you and/or your advocate should:

  • Be informed about your health condition and treatments to be sure you are getting the treatment you are supposed to be getting, when you are supposed to be getting it.
  • Learn who the various professionals are who treat you, and what each of their functions are. For example, a doctor known as a Hospitalist may be in charge of coordinating your medical care while in the hospital.
  • Be alert to what's going on.
  • Know your rights.
  • Be assertive. You can be assertive without being obnoxious.
  • Keep in mind that you do not have to be in pain.
  • Do what you can to help avoid unnecessary infection.
  • Keep track of treatments and services provided to you as they are provided.

If you have health insurance, do not rely on the hospital to check that all medical care providers are covered by your coverage. If your insurance only covers in-network doctors, it's up to you to be sure all medical personnel contract with your insurer. Otherwise, you may be stuck with the bill for that person's services. This is known as "Balance Billing." (To learn about the steps to take if you get billed under "Balance Billing", see "To Learn More.")

If you executed a Living Will or a Health Care Power of Attorney, ask a nurse to check to be sure they and the name of your health care proxy are noted in your chart. If you have executed a Do Not Resuscitate Order (DNR), it should be prominently noted throughout your chart so everyone who is involved with you will see it. (It also helps to hang a DNR sign above your bed - even if it is handwritten).

NOTE: 

  • You can keep family and friends up to date easily through such alternatives as free web sites designed for that purpose or simple phone trees. As noted above, if you think you may change jobs or seek a job in the foreseeable future, it is preferable not to use the internet to keep family and friends posted - or at least not with your real name. (For more information, see the document in "To Learn More.")
  • Historically, when visitors have been limited by a hospital, same-sex domestic partners have not been included. In addition to the right to have visits from your immediate legal family, your right to receive visitors has been extended in hospitals which receive money from Medicaid or Medicare to include a domestic partner - including a same-sex domestic partner.

For additional helpful information about a hospital stay, see the documents in "To Learn More."

Resection: Before You Leave The Hospital

Before you leave the hospital:
  • Get a discharge plan. The plan should include everything you will need to know for life after you leave the hospital so you know:
    • What to expect 
    • How to deal with situations that may arise 
    • What you can and cannot do, and 
    • When to call the doctor.
  • Request a copy of your medical records summarizing everything that happened in the hospital. 
    • Under law, you are entitled to a copy of your medical records.  
    • If you cannot get a copy to take with you, ask that it be mailed. Some hospitals require that you pick up medical records at the hospital at a later date. 
    • Take the copy to your next doctor's appointment. Then keep it with your copy of your medical records. (Yes! It is advisable to have your own copy of your medical records.)
  • Pre-arrange a follow-up appointment with your doctor.
    • It will save you the hassle of remembering to call when you get home.
    • You'll have a date to look forward to.
  • Remind your doctor that you do not want to be in pain.  
    • Ask for a prescription for strong pain medications.  You do not have to fill the prescription. If you do, you do not have to take the pills unless they are needed, or you can take smaller doses as warranted by splitting a pill.  (To learn about pill splitting, click here.)
    • If you have the prescription, you won’t have to take time to contact the doctor, get a prescription and fill the prescription after you go home. 
    • Many doctors tend to under treat pain. As noted above, it is a myth to think you will become addicted to pain medications if you take the meds for pain relief.
  • Plan ahead for your needs when you are discharged from the hospital. For example:
    • Wear clothes that are loose fitting and soft against what could be tender skin. 
      • For instance, a large button-front men's shirt or a house dress with snaps in the front, top to bottom. 
      • Assume any belongings you bring home from a hospital are contaminated and should be washed before being used again
  • If you have an ostomy: If you have access to the internet, this could be a good time to start shopping for items you may need post surgery.
  • Review the hospital bill
    • According to a variety of studies, the percentage of hospital bills that are wrong is quite high.
    • It is worth your while to take the time to review the bill – even if it is being paid for entirely by insurance. Survivorship A to Z shows you how, as well as to how to negotiate a hospital bill, in the document in “To Learn More.”  
  • If the hospital asks you to pay the bill before leaving:
    • If you don't have insurance, you can negotiate the bill. (Check it first. According to studies, most hospital bills have errors in the hospital’s favor. See “To Learn More.”)
    • If you do have insurance, check with your insurance company before paying.
  • If you will need home care after you leave the hospital, it is available. 
    • The discharge planner in the hospital will help to arrange care.
    • Ask a family member of trusted friend to look over your residence and put valuable items away - especially credit cards, cash, jewelry and other items that are small and look expensive so they aren't a temptation to a home care worker.
    • You can either hire an agency, or hire helpers on your own. There are pros and cons to each method which are discussed in the document in "To Learn More."
    • Home care may be covered by your health insurance.

NOTE: If there are health problems after you get homethe best way to ensure that you are covered by insurance is to return to the same hospital.  For example, postoperative care is part of surgery and follow-up will likely be part of it.  Surgery may begin when you enter the operating room but it does not end when you leave .

Resection: Side Effects of Surgery

Common side effects of colorectal surgery include:

  • Pain 
    • The time it takes to heal after surgery is different for each person. You may be uncomfortable for the first few days. Medicine can help control your pain.
    • Pain control is important in the healing process.  It is important to stay ahead of the pain. It is important that you take you pain medication as instructed and on a regular basis. It is preferable to stay ahead of the pain.
    • Before surgery, you should discuss the plan for pain relief with your doctor or nurse.
    • After surgery, your doctor can adjust the plan if you need more pain relief. 
    • Do not be concerned about becoming addicted to pain drugs. Studies indicate addiction doesn’t happen in these circumstances. (To learn how to deal with pain, see Pain 101).
  • Ostomy and Stoma
    • When a section of your colon or rectum is removed, the surgeon can usually reconnect the remaining sections. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave your body. The surgeon makes an opening, a stoma, in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.
    • For many people, the stoma is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent colostomy.
    • People who have a colostomy may have irritation of the skin around the stoma. Your doctor, your nurse, or an enterostomal therapist (a professional trained in ostomies) can teach you how to clean the area and prevent irritation and infection. (For information about minimizing risk of infection in your day-to-day life, click here). 
    • For more information about ostomies, including care of and living with, click here
  • Change in Bowel Function
    • Surgery sometimes causes constipation or diarrhea.  Your health care team monitors you for signs of bleeding, infection, or other problems requiring immediate treatment. (For information about how to avoid infection on a day-to-day basis, click here).
    • In order to avoid becoming constipated, drink plenty of water, eat foods that are high in fiber as recommended by your doctor and take stool softeners or laxatives as instructed. 
    • Do not use enemas within three months after surgery without instruction from your doctor. 
  • Urinary Function
    • With a rectal resection, urinary function may change because the nerves may be bruised during the surgery. 
    • While the loss of urinary control is generally not permanent,  some patients will need a urinary catheter for longer than usual, medication, or both on a temporary basis.
  • Fatigue. It is common to feel tired or weak for a while. To learn how to cope with fatigue, click here.
  • Sexual Function  
    • Men:  
      • A resection can cause “dry” orgasms with no ejaculation by damaging the nerves that control ejaculation. Alternatively, the result could be “retrograde ejaculation” – the semen goes backward into your bladder. With both dry orgasms and retrograde ejaculation a man can still get an erection. With retrograde ejaculation, a man can still father a child because doctors can recover sperm cells from urine or from testicles with minor surgery. The sperm is then used to impregnate a woman by means of in vitro fertilization.
      • It is possible that a resection may stop erections totally or the ability to reach orgasm.  There are alternatives to permit sex. See Erectile Dysfunction.
    • Women: There is generally no loss of sexual function, though the vagina may become dry or  irritated for a while which can cause painful intercourse. In some cases the change is permanent.

Open Surgery Compared To Laparoscopy (Laparoscopic Surgery)

Traditionally, the incision for colorectal cancer surgery is fairly large. This is known as “Open Surgery.” More recently, surgeons have been able to perform minimally invasive surgery by making small incisions through Laparoscopic or Robotic Surgery. 

The method of getting through the skin does not change the effectiveness of the treatment or change in the rate of long term survival. Neither does traditional surgery compared to robotic surgery. However, healing is usually faster with laparoscopic or robotic surgery because there is not a large incision in the skin. Also, doctors have noticed that patients with smaller entries have less scar tissue so we may start seeing less problems with bowel obstruction due to scar tissue and may start seeing lower incidence of hernia formation in patients with laparoscopies or robotic surgery. However, at the moment, that is just a "best guess."

A determination whether a patient is a candidate for a minimally invasive surgery instead of open surgery depends on several factors:

  • The skill and training of the surgeon.
  • The disease progression.
  • The patient's body weight. A patient who is morbidly obese (a BMI of more than 40) has a less likelihood of successfully being treated with a minimally invasive approach.
  • Patients with severe inflammatory bowel disease or severe diverticulitis may or may not be able to be treated with laparoscopy. 
Once inside, surgeons do the same work with either procedure. They remove the tumor and a short piece of healthy bowel on either side. The ends are then reconnected. Nearby organs such as the liver and lungs are checked to see if the cancer has spread. For information about the practical aspects of a resection operation, starting with preparation before the operation, see the other sections of this document. 

Open resection surgery
  • The surgeon makes a large cut into your abdomen.
  • The surgeon removes the tumor and part of the healthy colon. Nearby lymph nodes will also be removed. The surgeon checks the rest of your intestines, liver and possibly other organs to see if the cancer has spread.
  • Open surgery generally takes 1 – 4 hours .
  • The stay in the hospital is usually 4 – 7 days.

Laproscopic resection surgery

Laparoscopy is minimally invasive surgery which can accomplish the same result as more invasive traditional surgery by using a thin, lighted tube known as a laparascope. Any segment of the colon may be removed with a laparoscopy. Studies show that even obese patients and patients who have had prior surgery can have this surgery. 


 

  •  With a laparascopy, the incision is 2 inches or 3 or 4 tiny cuts of a quarter to one half inch in the abdomen instead of an 8-12 inch incision. (One of the incisions is used to inject carbon dioxide into the abdomen. The carbon dioxide separates the abdominal wall so the surgeon can operate). Sometimes only one small opening (port) is involved. (This is known as the No Visible Scar or Single Port Approach). The No Visible Scar approach moves the single cut to the area below the pubic hair line.
  • The surgeon sees inside your body on a video monitor by manipulating the laparoscope. He or she does the same procedure as in open surgery. 
  • Colon surgery using laparoscopy generally takes 2 – 4 hours .
  • The risks and complications are generally about the same as for open surgery. Complications are significantly higher for surgeons who do not have adequate training or do not do a large number of these procedures.
  • Most institutions doing the open surgery also use the laparoscopic technique.

Laparoscopic operations were first performed in 1991.

There are both short term and long term benefits to laparoscopy compared to traditional surgery.

  • In the short term:
    • Recovery is faster and easier because of the smaller incision:
    • There is less pain.
    • Less pain medicine is needed.
    • People can take deep breaths easier and get out bed and walk a lot sooner.
    • Less time is required for bowel function to recover.
    • People tend to do better in the hospital. For example, people can be fed pretty much right away, with something to drink and to advance the diet. People can generally leave the hospital within 3 – 5 days after the operation. 
    • Less blood loss.
    • Better quality of life.
  • In the longer term: Recovery at home is usually about 2 weeks compared to 6 to 8 weeks of recovery needed after a regular operation.

Most health insurance policies cover laparascopic surgery. At the least, policies pay the same as for an open operation. (How much a policy pays is generally a problem for the surgeon’s staff rather than for the patient).

For information about how to stay safe in a hospital and to maximize your stay, see the documents in "To Learn More" below.

Robotic Surgery for Rectal Cancer

Robotic surgery uses a minimally invasive high tech robotic instrument in a hospital to perform surgery. Robotic surgery is particularly useful for rectal surgery because of the tiny pelvic nerves around the rectum. Use of the robot helps reduce sexual and bladder problems. 

The procedure:

  • Unlike robots like R2D2, robotic instruments are controlled by a surgeon who controls every action of the surgical robot.
  • The procedure is much like a laparoscopy. 3 or 4 robotic instruments are inserted into the abdomen through small incisions. The surgeon controls the movements of the robotic instruments.
  • Robotic instruments are more precise and flexible than conventional laparoscopic tools and the surgeon’s view is 3 dimensional.
  • The procedure usually takes about 2 hours from start to finish. 
  • General anesthesia is used so there is no pain during the procedure and less pain afterwards than either open or laparoscopic resection.
  • Close to 90% of patients leave the hospital within 24 hours.  A few patients need an extra day – usually just for safety reasons.

Preparation for Robotic Surgery:

  • Your doctor will usually ask that you stop aspirin and blood thinners  7 – 10 days before surgery to avoid bleeding problems during the surgery.
  • Herbs , vitamins or supplements that may cause bleeding should also be stopped at least 10 days to 2 weeks before the operation.
  • There is no need to bank your blood before the operation because blood loss is usually just a few tablespoons.

Recovery from Robotic Surgery:

  • An advantage of robotic surgery is that it is better at sparing sensitive nerves that are involved in erectile and bladder functioning and the anal sphincter.

To Learn More